The Expedition Medicine team (www.expeditionmedicine.co.uk) have put together a nice review of field management of femur fracture, written by their medical director, Dr Amy Hughes. In particular, it has a good step-by-step pictorial guide for applying the Kendrick Traction Device (KTD), one of my favourite pieces of kit.
The degree of haemorrhagic compromise caused by even a simple closed femur fracture shouldn’t be understated: Expecting 1500ml of loss into the compartment, this by definition puts the patient into at least Class 2 shock. While it is good to see wilderness/expedition medics au fair with hypotensive resuscitation, we must not lose sight of the fact that maintaining adequate perfusion trumps the fear of dilutional coagulopathy and ‘clot-popping’, especially in the face of delayed/lengthy evacuation. It’s a fine balance, especially in the wilderness.
I’d also ike to see the analgesia section expanded a little – in particular, the use of femoral block and the addition of ketamine to the armamentarium – but as that’s one of my personal soap boxes and fields of interest I’ll cut them a little slack 😉
The other great things to see in print are the promotion of simple cephalosporin antibiotic prophylaxis (not the shocking top-end drugs being advised from our US tactical compatriots) and encouragement to use adequate irrigation (utilising Wilderness And Tactical Environmental Rinse, aka WATER, *grin*). Cue one of my favourite quotes: “The solution to the pollution is dilution!”
Kudo’s on a good blog, folks.